Healthcare Provider Details

I. General information

NPI: 1194483255
Provider Name (Legal Business Name): SHARON MARY KATNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 160 163 BUILDING
KAYENTA AZ
86033
US

IV. Provider business mailing address

2105 VISTA OESTE NW # 2
ALBUQUERQUE NM
87120-3693
US

V. Phone/Fax

Practice location:
  • Phone: 928-697-4202
  • Fax:
Mailing address:
  • Phone: 360-310-7550
  • Fax: 928-697-4083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR40335
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: